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The prevalence of giardiasis in patients with acute enterocolitis from Timis County, Romania
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14th International Congress on Infectious Diseases (ICID) Abstracts
aspects of D. fragilis, including its epidemiology, still need more study in order to improve the understanding of this emerging parasite. Methods: In the context of a Venezuelan Study on Human Growth and Development (SENACREDH), a cross-sectional study of 3388 asymptomatic individuals (1656 male, 1732 female; mean age 13.05 ± 0.22year-old) from 40 municipalities of North Central Venezuelan states (Aragua, Carabobo, Miranda, Vargas and Capital District) was carried out. Dientamoeba fragilis was diagnosed in stool samples after being preserved in MIF media. Results: We found a prevalence of 1.8% (95%CI1.39—2.32%). From the total of individuals with D. fragilis infection (61), 52.5% were females and 47.5% males. Mean age was 14.37years-old(±12.59). Prevalence according to sex was not different (p = 0.935), neither to age (p = 0.144). From those infected, 10.9% presented anemia (6.54% microcytic hypocromic), 43.5% presented relative eosinophilia. Mean haemoglobin was 13.07 g/dL(10.8—14.9 g/dL), mean %eosinophils 5.17%(0—23%), and mean eosinophils count 396.93 cells/mm3(0—1760 cells/mm3 ). Co-infections with other parasites were identified: 80.3% Blastocystis hominis, 27.9% Endolimax nana, 26.2% Iodamoeba butschlii, 13.1% Entamoeba coli, 9.8% Giardia lamblia, 8.2% Ascaris lumbricoides, 1.6% Trichuris trichiura, 1.6% Hymenolepis nana and 1.6% Entamoeba histolytica/dispar. Conclusion: Eosinophilia has been occasionally described in cases of D. fragilis infection. However, herein a significant proportion of patients presented it suggesting a pathological role of this protozoan. As has been previously reported a significant proportion of helminth and other protozoan coinfections was found in this study, suggesting a shared transmission mode with these enteric parasites. There are great gaps in our present state of knowledge concerning the virulence, pathogenicity, and mode of transmission of D. fragilis. However, the neglect of D. fragilis as an emergent parasite should not longer be justified as there are a growing number of reports incriminating it in different enteric diseases. doi:10.1016/j.ijid.2010.02.2142 58.019 Risk factors in patients with trichinellosis from Western Romania I. Marincu ∗ , L. Negrutiu, A.M. Neghina, I. Iacobiciu, R. Neghina Victor Babes University of Medicine and Pharmacy Timisoara, Romania, Timisoara, Romania Background: Trichinellosis continues to be an important public health issue in Romania due to the consumption of unverified pork from unauthorized sources. Authors of the present paper established the risk factors in a study group of patients diagnosed with trichinellosis. Methods: We have retrospectively analyzed the medical charts of 121 patients, inhabitants of four trichinellosis endemic areas in Timis County, Romania who were admitted to Hospital of Infectious Diseases Timisoara during 20022009. The diagnosis was based upon epidemiologic features
(the onset of infection following consumption of infected pork with Trichinella spiralis), clinical features (fever, headache, chills, nausea, diarrhea, facial edema, myalgia, urticaria etc.) and laboratory tests (erythrocyte sedimentation rate, fibrinogen, antibodies against Trichinella spiralis, leukocyte counts, eosinophil counts etc). The results of the monitoring of the clinical, laboratory and therapeutic parameters were registered in the individual files of the patients. Epi Info soft was used for the statistical processing of data. Results: There have been recorded two trichinellosis foci both in rural (Iecea — 26 cases and Padureni — 5 cases) and urban regions (Kuncz — 57 cases and Ronat — 33 cases). According to the ethnic origin of the patients, 95.86% of them belonged to the gipsy minority, characterized by a low level of education (without respect to the basic individual or collective hygienic alimentary rules), and specific unhealthy and unsafe food habits. Although they were in the evidences of general practitioners, only 9 of them (7.75%) used to benefit of the regular medical visits. Nevertheless they didn’t buy the prescribed drugs and didn’t follow the indicated therapy. All of the patients had consumed unverified pork infected with Trichinella spiralis that was illegally traded. In Iecea focus the consumed meat was taken by the gypsies from a septic tank where it was deposited for destruction. Thirty-eight patients (30.17%) had consumed undercooked pork and additional pork products (smoked sausages). During the hospitalization, 86.20% of the gypsy patients presented an inadequate and recalcitrant behavior. Conclusion: The study of the risk factors for trichinellosis allows the implementation of programs for prophylaxis and decrease of the incidence of disease in regions where this severe zoonosis is widespread. doi:10.1016/j.ijid.2010.02.2143 58.020 The prevalence of giardiasis in patients with acute enterocolitis from Timis County, Romania I. Marincu ∗ , L. Negrutiu, I. Iacobiciu, A.M. Neghina, R. Neghina Victor Babes University of Medicine and Pharmacy Timisoara, Romania, Timisoara, Romania Background: According to its increased incidence and severe complications, acute enterocolitis continues to represent a global major public health concern. The present study aimed to determine the prevalence of giardiasis in a group of patients diagnosed with acute enterocolitis in Timis County, Romania. Methods: We have retrospectively analyzed the medical charts of 84 adult patients diagnosed with acute enterocolitis who were admitted at the Hospital of Infectious Disease in Timisoara. The diagnosis was established upon clinical features (fever, abdominal colic, repeated watery diarrheic stools, dehydration, asthenia, unspecific cutaneous eruption, muscular cramps etc.), laboratory tests (leukocyte counts, leukocytic formula, erythrocyte sedimentation rate, fibrinogen, C-reactive protein, stool culture, stool examination, natremia, kalemia, calcaemia etc.) and other explorations (abdominal echography, electrocardiography).
14th International Congress on Infectious Diseases (ICID) Abstracts Stool examinations, repeated after 1 to 2 days, were performed in all patients to detect Giardia lamblia cysts. Results: Of the 84 patients included in the study group, in 8 cases (9.52%) were detected Giardia lamblia cysts. The epidemiologic investigation revealed that 5 patients were married, 2 were living in a student hostel, and one was living alone. All patients were professionally active and part of collective with over 10 individuals. Five patients presented a maculopapular urticarial eruption disseminated on thorax, abdomen and limbs, and accompanied by a moderately pruritus. All patients followed a diet and a treatment with albendazole (2 × 200 mg daily, 5 days), antispasmodics, antipyretics, calcium. Six of them required a hydroelectrolytic replacement with different infusions (Ringer, glucose, physiological serum). Three out of the 8 patients were ambulatory treated with antibiotics prior to hospitalization. Nevertheless the symptoms didn’t remit and consequently they necessitated hospitalization. The stool exams of the family members (in 5 patients with families) showed the relevance of setting of the ambulatory antiparasitic therapy for the whole family. The outcome was favorable in all cases. Adverse reactions were minor and transitional: nausea in 3 cases, bitter taste 2 cases, and pyrosis 2 cases. Conclusion: The early detection of giardiasis in patients with acute enterocolitis avoids unnecessary administration of antibiotics and allows the administration of the antiparasitic therapy with optimal clinical results and decrease the spread of this affection. doi:10.1016/j.ijid.2010.02.2144 58.021 Immunological changes in children with giardiasis T.R. Olariu 1,∗ , V. Dumitrascu 2 , I. Marincu 3 , C. Petrescu 2 , A. Koreck 2 1
Victor Babes University of Timisoara, Timisoara, Romania 2 Victor Babes University of Timisoara, Romania 3 Victor Babes University of Timisoara, Romania, Timisoara,
Medicine and Pharmacy Medicine and Pharmacy, Medicine and Pharmacy Romania
Background: Giardia lamblia is an intestinal parasite which has been diagnosed with an increase frequency among Romanian institutionalized children. The aim of the present study was to assess peripheral blood lymphocytes populations and serum cytokine levels for IL-4 and IFN-/ in children infected with Giardia lamblia. Methods: Lymphocyte subpopulations were determined using flowcytometry and cytokines were quantified by sandwich ELISA. Results: Total T cells, CD4+ helper T cells, activated T cells (HLA-DR+ or CD25+) and NK cells did not differ significantly between children with Giardia lamblia infection and agedmatched healthy controls. In contrast, CD8+ T cell were elevated in Giardia lamblia (34.42 ± 6.08%) infected children compared to controls (27.66 ± 2.15%). B cells were significantly reduced in the peripheral blood of children with giardiasis (16.89 ± 2.44%) compared to healthy controls (26.41 ± 4.12%). IL-4 was detected in higher con-
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centration in the serum of children infected with Giardia lamblia (4.19 ± 1.67 pg/ml) and was not detected in the serum of healthy children. IFN−/ levels were elevated in children with giardiasis (5.7 ± 5.04 pg/ml) compared to controls (0.79 ± 0.47 pg/ml). Conclusion: Our data suggest that Giardia lamblia infections in children may be accompanied by systemic immunological changes. doi:10.1016/j.ijid.2010.02.2145 58.022 IgG antibodies relative avidity as a phase-specific diagnosis for toxocariasis in populations of Venezuela O. Delgado, J. Ortegoza, V. Coraspe, M.A. Rivas, S. Silvia, C. Duran, Y. Pascual, A. Rodriguez-Morales ∗ Immunoparasitology Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela Background: IgG-Avidity ELISA has been recently developed in toxocariasis as a useful technique for ruling out recently acquired infections. Avidity of antibodies increases with time after antigen challenge and the measurement of the avidity has been used to diagnose various infections especially when differentiation of recent and distant infections is crucial. Methods: In this study we focused on a method for distinguishing acute and chronic Toxocara infection in children and adults, the basis of which was the assessment of specific IgG antibodies avidity. We studied 400 serum samples collected from populations in Venezuela (aged 1—65y, 52% male). Results: From this population screening with a validated ELISA (with locally prepared T.canis excretion-secretion antigens) we serologically diagnosed 71.25% of them (62% 1:128dils). From these serologically positive patients we evaluated the Toxocara-specific IgG avidity, which was measured employing the dissociative method using urea as a denaturing agent and the calculation of a relative avidity index. The relative avidity index was calculated as the ratio of IgG values in sera treated with urea and the value of IgG in nontreated sera (x100). Values on this index)50 were considered as low avidity (indicating recently acquired infection) and those >50 were considered as indicative of high avidity (chronic infection). In the sera from these patients low index of IgG antibodies avidity was shown in 71.25%; 50% of these patients presented avidity values)33. These values were independent of the ELISA titers of these patients (t = 0.207; p = 0.837), age (F = 0.234, p = 0.631), sex (t = 0.624; p = 0.536) and epidemiological risk factor such as dog ownership (t = 0.955; p = 0.348). In the group of patients with titers of 1:32dils mean avidity was 32.7(low index of IgG), in those with 1:128dils mean avidity was 31.9(low index of IgG) (p > 0.05). Compared with IgG avidity test, conventional ELISA had just 32.9% of specifity (95%CI28.2—38.0). Conclusion: These results, as other previous, suggest that measurement of specific IgG avidity (which is independent of the ELISA titers) may assist in the discrimination between
14th International Congress on Infectious Diseases (ICID) Abstracts
aspects of D. fragilis, including its epidemiology, still need more study in order to improve the understanding of this emerging parasite. Methods: In the context of a Venezuelan Study on Human Growth and Development (SENACREDH), a cross-sectional study of 3388 asymptomatic individuals (1656 male, 1732 female; mean age 13.05 ± 0.22year-old) from 40 municipalities of North Central Venezuelan states (Aragua, Carabobo, Miranda, Vargas and Capital District) was carried out. Dientamoeba fragilis was diagnosed in stool samples after being preserved in MIF media. Results: We found a prevalence of 1.8% (95%CI1.39—2.32%). From the total of individuals with D. fragilis infection (61), 52.5% were females and 47.5% males. Mean age was 14.37years-old(±12.59). Prevalence according to sex was not different (p = 0.935), neither to age (p = 0.144). From those infected, 10.9% presented anemia (6.54% microcytic hypocromic), 43.5% presented relative eosinophilia. Mean haemoglobin was 13.07 g/dL(10.8—14.9 g/dL), mean %eosinophils 5.17%(0—23%), and mean eosinophils count 396.93 cells/mm3(0—1760 cells/mm3 ). Co-infections with other parasites were identified: 80.3% Blastocystis hominis, 27.9% Endolimax nana, 26.2% Iodamoeba butschlii, 13.1% Entamoeba coli, 9.8% Giardia lamblia, 8.2% Ascaris lumbricoides, 1.6% Trichuris trichiura, 1.6% Hymenolepis nana and 1.6% Entamoeba histolytica/dispar. Conclusion: Eosinophilia has been occasionally described in cases of D. fragilis infection. However, herein a significant proportion of patients presented it suggesting a pathological role of this protozoan. As has been previously reported a significant proportion of helminth and other protozoan coinfections was found in this study, suggesting a shared transmission mode with these enteric parasites. There are great gaps in our present state of knowledge concerning the virulence, pathogenicity, and mode of transmission of D. fragilis. However, the neglect of D. fragilis as an emergent parasite should not longer be justified as there are a growing number of reports incriminating it in different enteric diseases. doi:10.1016/j.ijid.2010.02.2142 58.019 Risk factors in patients with trichinellosis from Western Romania I. Marincu ∗ , L. Negrutiu, A.M. Neghina, I. Iacobiciu, R. Neghina Victor Babes University of Medicine and Pharmacy Timisoara, Romania, Timisoara, Romania Background: Trichinellosis continues to be an important public health issue in Romania due to the consumption of unverified pork from unauthorized sources. Authors of the present paper established the risk factors in a study group of patients diagnosed with trichinellosis. Methods: We have retrospectively analyzed the medical charts of 121 patients, inhabitants of four trichinellosis endemic areas in Timis County, Romania who were admitted to Hospital of Infectious Diseases Timisoara during 20022009. The diagnosis was based upon epidemiologic features
(the onset of infection following consumption of infected pork with Trichinella spiralis), clinical features (fever, headache, chills, nausea, diarrhea, facial edema, myalgia, urticaria etc.) and laboratory tests (erythrocyte sedimentation rate, fibrinogen, antibodies against Trichinella spiralis, leukocyte counts, eosinophil counts etc). The results of the monitoring of the clinical, laboratory and therapeutic parameters were registered in the individual files of the patients. Epi Info soft was used for the statistical processing of data. Results: There have been recorded two trichinellosis foci both in rural (Iecea — 26 cases and Padureni — 5 cases) and urban regions (Kuncz — 57 cases and Ronat — 33 cases). According to the ethnic origin of the patients, 95.86% of them belonged to the gipsy minority, characterized by a low level of education (without respect to the basic individual or collective hygienic alimentary rules), and specific unhealthy and unsafe food habits. Although they were in the evidences of general practitioners, only 9 of them (7.75%) used to benefit of the regular medical visits. Nevertheless they didn’t buy the prescribed drugs and didn’t follow the indicated therapy. All of the patients had consumed unverified pork infected with Trichinella spiralis that was illegally traded. In Iecea focus the consumed meat was taken by the gypsies from a septic tank where it was deposited for destruction. Thirty-eight patients (30.17%) had consumed undercooked pork and additional pork products (smoked sausages). During the hospitalization, 86.20% of the gypsy patients presented an inadequate and recalcitrant behavior. Conclusion: The study of the risk factors for trichinellosis allows the implementation of programs for prophylaxis and decrease of the incidence of disease in regions where this severe zoonosis is widespread. doi:10.1016/j.ijid.2010.02.2143 58.020 The prevalence of giardiasis in patients with acute enterocolitis from Timis County, Romania I. Marincu ∗ , L. Negrutiu, I. Iacobiciu, A.M. Neghina, R. Neghina Victor Babes University of Medicine and Pharmacy Timisoara, Romania, Timisoara, Romania Background: According to its increased incidence and severe complications, acute enterocolitis continues to represent a global major public health concern. The present study aimed to determine the prevalence of giardiasis in a group of patients diagnosed with acute enterocolitis in Timis County, Romania. Methods: We have retrospectively analyzed the medical charts of 84 adult patients diagnosed with acute enterocolitis who were admitted at the Hospital of Infectious Disease in Timisoara. The diagnosis was established upon clinical features (fever, abdominal colic, repeated watery diarrheic stools, dehydration, asthenia, unspecific cutaneous eruption, muscular cramps etc.), laboratory tests (leukocyte counts, leukocytic formula, erythrocyte sedimentation rate, fibrinogen, C-reactive protein, stool culture, stool examination, natremia, kalemia, calcaemia etc.) and other explorations (abdominal echography, electrocardiography).
14th International Congress on Infectious Diseases (ICID) Abstracts Stool examinations, repeated after 1 to 2 days, were performed in all patients to detect Giardia lamblia cysts. Results: Of the 84 patients included in the study group, in 8 cases (9.52%) were detected Giardia lamblia cysts. The epidemiologic investigation revealed that 5 patients were married, 2 were living in a student hostel, and one was living alone. All patients were professionally active and part of collective with over 10 individuals. Five patients presented a maculopapular urticarial eruption disseminated on thorax, abdomen and limbs, and accompanied by a moderately pruritus. All patients followed a diet and a treatment with albendazole (2 × 200 mg daily, 5 days), antispasmodics, antipyretics, calcium. Six of them required a hydroelectrolytic replacement with different infusions (Ringer, glucose, physiological serum). Three out of the 8 patients were ambulatory treated with antibiotics prior to hospitalization. Nevertheless the symptoms didn’t remit and consequently they necessitated hospitalization. The stool exams of the family members (in 5 patients with families) showed the relevance of setting of the ambulatory antiparasitic therapy for the whole family. The outcome was favorable in all cases. Adverse reactions were minor and transitional: nausea in 3 cases, bitter taste 2 cases, and pyrosis 2 cases. Conclusion: The early detection of giardiasis in patients with acute enterocolitis avoids unnecessary administration of antibiotics and allows the administration of the antiparasitic therapy with optimal clinical results and decrease the spread of this affection. doi:10.1016/j.ijid.2010.02.2144 58.021 Immunological changes in children with giardiasis T.R. Olariu 1,∗ , V. Dumitrascu 2 , I. Marincu 3 , C. Petrescu 2 , A. Koreck 2 1
Victor Babes University of Timisoara, Timisoara, Romania 2 Victor Babes University of Timisoara, Romania 3 Victor Babes University of Timisoara, Romania, Timisoara,
Medicine and Pharmacy Medicine and Pharmacy, Medicine and Pharmacy Romania
Background: Giardia lamblia is an intestinal parasite which has been diagnosed with an increase frequency among Romanian institutionalized children. The aim of the present study was to assess peripheral blood lymphocytes populations and serum cytokine levels for IL-4 and IFN-/ in children infected with Giardia lamblia. Methods: Lymphocyte subpopulations were determined using flowcytometry and cytokines were quantified by sandwich ELISA. Results: Total T cells, CD4+ helper T cells, activated T cells (HLA-DR+ or CD25+) and NK cells did not differ significantly between children with Giardia lamblia infection and agedmatched healthy controls. In contrast, CD8+ T cell were elevated in Giardia lamblia (34.42 ± 6.08%) infected children compared to controls (27.66 ± 2.15%). B cells were significantly reduced in the peripheral blood of children with giardiasis (16.89 ± 2.44%) compared to healthy controls (26.41 ± 4.12%). IL-4 was detected in higher con-
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centration in the serum of children infected with Giardia lamblia (4.19 ± 1.67 pg/ml) and was not detected in the serum of healthy children. IFN−/ levels were elevated in children with giardiasis (5.7 ± 5.04 pg/ml) compared to controls (0.79 ± 0.47 pg/ml). Conclusion: Our data suggest that Giardia lamblia infections in children may be accompanied by systemic immunological changes. doi:10.1016/j.ijid.2010.02.2145 58.022 IgG antibodies relative avidity as a phase-specific diagnosis for toxocariasis in populations of Venezuela O. Delgado, J. Ortegoza, V. Coraspe, M.A. Rivas, S. Silvia, C. Duran, Y. Pascual, A. Rodriguez-Morales ∗ Immunoparasitology Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Venezuela Background: IgG-Avidity ELISA has been recently developed in toxocariasis as a useful technique for ruling out recently acquired infections. Avidity of antibodies increases with time after antigen challenge and the measurement of the avidity has been used to diagnose various infections especially when differentiation of recent and distant infections is crucial. Methods: In this study we focused on a method for distinguishing acute and chronic Toxocara infection in children and adults, the basis of which was the assessment of specific IgG antibodies avidity. We studied 400 serum samples collected from populations in Venezuela (aged 1—65y, 52% male). Results: From this population screening with a validated ELISA (with locally prepared T.canis excretion-secretion antigens) we serologically diagnosed 71.25% of them (62% 1:128dils). From these serologically positive patients we evaluated the Toxocara-specific IgG avidity, which was measured employing the dissociative method using urea as a denaturing agent and the calculation of a relative avidity index. The relative avidity index was calculated as the ratio of IgG values in sera treated with urea and the value of IgG in nontreated sera (x100). Values on this index)50 were considered as low avidity (indicating recently acquired infection) and those >50 were considered as indicative of high avidity (chronic infection). In the sera from these patients low index of IgG antibodies avidity was shown in 71.25%; 50% of these patients presented avidity values)33. These values were independent of the ELISA titers of these patients (t = 0.207; p = 0.837), age (F = 0.234, p = 0.631), sex (t = 0.624; p = 0.536) and epidemiological risk factor such as dog ownership (t = 0.955; p = 0.348). In the group of patients with titers of 1:32dils mean avidity was 32.7(low index of IgG), in those with 1:128dils mean avidity was 31.9(low index of IgG) (p > 0.05). Compared with IgG avidity test, conventional ELISA had just 32.9% of specifity (95%CI28.2—38.0). Conclusion: These results, as other previous, suggest that measurement of specific IgG avidity (which is independent of the ELISA titers) may assist in the discrimination between